Wednesday, October 31, 2007

A 33-year old man with chest pain

Dropped dead waiting outside the ER, 3-hours after being triaged. WhiteCoat Rants comments.

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Catholic pharmacists and the Pope

Duty to the patient or their religion?
Benedict told a gathering of Catholic pharmacists Monday that they have the right to refuse to dispense emergency contraception or euthanasia drugs to people who have been given prescriptions by their doctors. He also said they should inform patients of the ethical implications of using certain drugs.

That's objectionable on many levels. But what next? Will the pope demand that pharmacists be required to ask women seeking fertility drugs if they are married? Should those pharmacists feel an obligation to ask men to prove they are straight and married before dispensing drugs that enhance sexual performance or stem AIDS? And should pharmacists of the future be allowed to prevent patients from receiving drugs developed through stem cell research?

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Forcing the medical sector to compete for patients

I agree that this would be a helpful approach. I don't see it happening anything soon.

As physician shortages are projected to explode (in primary care anyways), it will be the patients increasingly competing for physicians. For every patient that leaves a primary care practice, 10 more will be in line waiting to sign up.

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The system shuts down another PCP

Patients continue to lose, as more of these stories are surfacing:
Lalka, 54, says that with an income of only $60,000 last year, and little opportunity to expand his practice, he no longer is able to make ends meet.

“I am giving up my practice, the love of my life,” he said recently as he stared out of his office window . . .

. . . “Here is a doctor who is not retiring because he wants to,” says Constance Mondel, 81, who Lalka has treated for many years. “He is leaving because the system is not working. It’s a real shame.”

Her husband, Joseph Mondel, 78, said that his first reaction to the news was fear and then anger.

“Who is going to take care of me in my aging life?” he asked. “What the hell do I do now?”

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"The best thing this country can do to improve the health care system is to just take better care of itself"

One of the more balanced opinions of our health care systems.

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Canadians are willing to jump the queues

If they only could:
* About 71 percent said they would likely or definitely speak to a neighbor who is a secretary at an MRI clinic if it meant getting moved up a list instead of waiting three months

* Some 30 percent would give their surgeon tickets to basketball and hockey games if it meant getting hip replacement surgery faster.

* Just over 50 percent were willing to pay a $20 "emergency fee" to see a dermatologist about an unattractive but apparently harmless rash instead of waiting three months.

* Another 56 percent said they would likely or definitely let a doctor who owes them a favor move them up a waiting list for cataract surgery.

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The overzealous Texas Board of Medicine

Some are saying that the Board is going too far in disciplining doctors and listening to anonymous complaints:
One by one, angry, frustrated doctors from Houston to Laredo took the microphone at a legislative hearing in Austin, spilling woeful tales of overzealous oversight — grueling, expensive probes, witch hunts, railroading — allegedly committ
(via Every Patient's Advocate)

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P4P gone wild in the NHS

Average PCP salary rises to an average of $226,000, most of it due to quality incentives.

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Patient perceptions and defensive medicine

One of many reasons why too many tests are ordered:
Some patients have significant misperceptions about the way medicine is, or should be, practiced. Even if these patients have no basis for their misperceptions, all they need to do is complain about an emergency physician and the doctor will hear about it. There is a constant dynamic tension in the ED: administrators and hospital boards want patients to be happy, but physicians know that patient happiness doesn’t always flow from proper medical care.

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Should apologies be admissible in court?

There's no real direction on the issue, so physicians often err on the side of secrecy:
"Doctors are very confused," said Dr. Tom Delbanco, an internist at Beth Israel Deaconess Medical Center who recently made a film, "When Things Go Wrong, Voices of Patients and Families. "Some [people] tell them to open their hearts and spill the beans. Others tell them to keep their mouths shut. It depends on the lawyer."

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The sculpted six-pack

The new rage in plastic surgery:
The suction six-pack costs between $4,000 and $7,000 and is only suitable for certain patients, Aldo Benjamin Guerra, the Arizona plastic surgeon who authored the abstract, told us. “I probably turn down about twice as many patients as I work on,” he said. “You have to have a certain amount of fat. If you have too little or too much you’re not going to get the definition.”

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Uninsured vets

So much for the pseudo-single payer VA providing universal coverage:
About one of every eight veterans under the age of 65 is uninsured, a finding that contradicts the assumption many have that all vets qualify for free health care through the Department of Veterans Affairs, says a new study.
(via The Medical Quack)

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Job board



The latest jobs on the Kevin, M.D. Job Board:


Together with The Health Care Blog, your job post will be viewed by readers of two prominent health care blogs, with a targeted audience of physicians, nurses, health IT, and other health professionals.

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Marcus Welby is dead

Older doctors are looking to jump off the Titanic:
When Baby Boom doctors entered medicine they had control over how they practiced and the fee they charged. But the rules changed on them in mid-stream and now many are looking for a ticket out.
(via The Medical Quack)

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More screening isn't necessarily better

A mantra I have been preaching for some time. Some untoward effects from newborn screening are starting to be realized:
The recent adoption of widespread screening of newborns for congenital health problems is saving thousands of lives every year, identifying potentially deadly conditions in time to begin treatment. But now, health-care professionals recognize that success has highlighted glitches in the system.

More screening has meant more potential for erroneous test results and misdiagnoses, causing needless angst for parents. Doctors and hospital officials, who must inform new parents about the screening process, are often ill-informed about the diseases that are screened for and how they are treated. And once a diagnosis is confirmed, families may get little follow-up as they struggle with the overwhelming rigors of caring for their sick infant.
(via Schwitzer)

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Write 200 prescriptions for a car

Developing countries are ripe for pharmaceutical bribery of doctors:
Gifts include air conditioners, laptops, club membership, domestic cattle, foreign conferences at five-star hotels, brand new cars and school tuition fees, according to the report. Murad Khan, professor and chairman of the department of psychiatry at Aga Khan University, told researchers that in Pakistan “for writing 200 prescriptions of the company’s high priced drug, a doctor is rewarded with the down payment of a brand new car.”

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Reflecting on the Day of the Dead

Pallimed on embracing mortality as a celebration of life.

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Halloween and medicine

Maria does a literature search. Happy Halloween everyone.

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No smoking, no health care



(via Catron)

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Restless legs syndrome

Disease mongering at its finest?

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The impact of foreign physicians

Many would like to see a flood of foreign doctors bring down physician salaries:
In a 2003 study Baker, who is co-director of the Center for Economic and Policy Research, estimates that by adding roughly 100,000 physicians to our current pool of about 760,000, we could pull doctors’ salaries down from an average of $203,000 to somewhere between $74,000 and $126,000. For the average middle-class American family of four he reckons that would lead to savings of $2,200 to $3,700 per year.
So far, it hasn't happened.

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Institutionalizing drunks?

A radical suggestion from ERnursey:
. . . these people take up a huge amount of medical resources being paid for by your tax dollars. Since they can not appropriately take care of themselves they should be institutionalized which would be much cheaper for the taxpayers.

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Emergency nursing, in pitcures

The night shift, in 1000 words.

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The Health FICO score

A novel way to measure quality.

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Miserable in medical school?

Like Dr. Centor, I enjoyed the last two (clinical) years markedly more than the first two. Why is that?

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Giuliani brings his prostate cancer into the debate

Some of the numbers he's quoting are being disputed:
"I had prostate cancer five, six years ago," Mr. Giuliani, a Republican presidential candidate, said in a speech that has been turned into the radio commercial. "My chance of surviving prostate cancer — and, thank God, I was cured of it — in the United States? Eighty-two percent. My chance of surviving prostate cancer in England? Only 44 percent under socialized medicine."

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Brain MRIs and crime

Can they play a larger role in criminal trials?
. . . today, scientists have developed noninvasive brain scans that may reveal whether a person has a brain abnormality that could affect decision-making or trigger violence, with huge implications for the law.

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Bargain cosmetic surgery

You'll have to travel to South America:
Like thousands of others, mostly from the United States, Europe, and Canada, Condon was drawn to South America's attractive exchange rates and reputable doctors who are highly skilled due to a local rage for cosmetic surgery.

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Avandia pulled from the VA formulary

Although this drug has its share of problems, it is still useful in selected populations, and for those who are hesitant to start an injectable diabetes medication.

Cost is the only reason why this medication was pulled, leaving vets with one less therapeutic option for their diabetes.

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iMedExchange



I would like to thank iMedExchange for their continuing Premium Sponsorship at Kevin M.D.

iMedExchange is a new online physician community. Currently in Beta, they are working with a team of physician advisors who provide guidance and insight through the iMedExchange Advisor Network.

"Physicians today are highly challenged, and we need help managing our personal lives, practices and patients. iMedExchange gives me access to a community of physicians that can be my greatest resource. I joined the iMedExchange Advisor Network (iAN), and became one of the many physician investors in order to be a part of this powerful solution for physicians."
- R. Maoud, M.D. (Internist, iAN Member, Physician Investor)

iMedExchange is looking for physicians to serve as advisors by giving feedback on new features, ideas, and community value. The time commitment is 10 minutes per week, from your own computer. In return for their time, advisors earn 100 stock options per month. Please join the community, and become an advisor, by visiting www.iMedExchange.com.

Sponsorship opportunities continue to be available. This can be via a Standard Blogad or a customized package. Please visit the advertising information page for further details.

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Tuesday, October 30, 2007

How the government destroyed this rural cancer practice

Still want single-payer after reading this story from California?
As a former rural breast cancer surgeon whose practice consisted largely of uninsured and underinsured women, I am uncertain why the same group that brought taxpayers $20,000 toilet seats should be in charge of the medical treatment choices patients and their families make.

As a provider of government medicine, I’ve seen the low quality of decision-making offered when it is shifted from patients and their doctors to Sacramento bureaucrats.
(via Instapundit)

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MedBlog Power 8

10/25/2007 - 11/01/2007
Next revision: 11/01/2007



(Key: Rank, Blog name, Last week's rank, Post of note)

1) Surgeonsblog (1), Visual Fields

2) Made A Difference For That One (-), Come see us at work

3) Musings of a Distractable Mind (2), The Great Divide

4) The Physician Executive (5), MRSA Scare: A Primer

5) Health Beat (-), Universal Coverage – Why Massachusetts is the Last Place to Begin the Experiment

6) Diabetes Mine (3), Exubera Goes Phhhttt... What Now?

7) Suture for a Living (8), Poststernotomy Mediastinitis and Repair

8) Street Anatomy (-), The World’s Most Viewed Medical Animation

The MedBlog Power 8 is a list of medical blogs that have had an exceptional week of blogging, based purely on my subjective measures. Factors I consider are how provocative the posts are, the amount of discussion it generates, and posting frequency.

The list is revised every Thursday and will be published every 1-2 days on Kevin, M.D. If you want me to consider your exceptional week of blogging, you can contact me.

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A string of complications

A 75-year old woman suffers an MI, which was only the start of her problems. Subsequently she had:

i) broken ribs from CPR
ii) a broken nose and skin tears due to a fall from her hospital bed
iii) facial burns, from a fire trigger by electrocautery of her wounds.

That's one tough hospital course.

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Niacin to beat drug tests

"As drug testing becomes more common, so will incidents of niacin poisoning."

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10 overused tests and treatments

Consumer Reports on media-hyped tests and treatments. Several newer modalities, like virtual colonoscopy and CT-angiograms, make the controversial list.

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Grand rounds is up

Running a hospital hosts this week. Come get the weekly best of the medical blogosphere.

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The language of the South

Edwin Leap on the Southern language nuances in his ED.

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Are over half of nurses on antidepressants?

Maggie Mahar on the deteriorating work environment for nurses:
Asked if they are on anti-depressants: 52.8 % of those who answered the poll responded, “Couldn’t make it without them;” over 18% checked, “No, but I think I need some;” and over 22% replied, “No, but I know a lot of nurses who are.”

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Bacterial infection and cancer

In light of recent news on bacterial resistance, Derek Lowe wonders if we have to re-think the antibacterial medication paradigm:
. . . researchers will have to rethink their attitudes towards antiinfective drugs. For serious infections, we're going to have to think about these projects the way we've traditionally thought of oncology agents - last-ditch therapies for deadly conditions. Anticancer therapies have long had more latitude in their side effects, therapeutic ratios, and dosing regimes, and antibiotics for resistant infections are in the same position.

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The young and the medicated

Younger adults are increasingly using cholesterol and blood pressure medication. Is this really good news?
. . . experts point to higher rates of obesity, high blood pressure and high cholesterol problems among young people, the Associated Press reports. Also, docs are getting more aggressive with preventive treatments. “This is good news, that more people in this age range are taking these medicines,” said Dan Jones, president of the American Heart Association, tells the AP.

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July syndrome

Myth or real?

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An ED, not a hotel

Sometimes a menu may be more appropriate for demanding ED patients.

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The beauty of wound healing

Sid Schwab discusses the healing ridge:
As much as feeling the healing ridge can alarm the unexpecting, it's a sign of health, the indication that help is on the way, that work is going on to effect healing.

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Glomus tumor

Suture for a Living takes a look at this rare hand tumor.

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Breastfeeding doesn't cause breasts to sag

The latest word from the plastic surgeons.

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The magic respiratory rate

Always seems to be 20, no matter what the situation.

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Can banning abortion lead to death?

Here are a couple of cases that illustrates the clinical gray area of banning abortion:
Once abortion becomes illegal here physicians will face jail time for caring for these septic abortion patients. So, fingers crossed and let's all hope these patients will be considerate enough to expire before they get to the hospital.

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Epocrates



I would like to thank Epocrates.com for their continuing sponsorship at Kevin, M.D.

Epocrates helps you prevent the spread of defensive medicine. Their products enable users to make clinical decisions more quickly and confidently, reducing the number of medical errors/adverse drug events.
* Over 60% of physicians believe that using Epocrates drug reference has helped them to avoid 3 or more adverse drug events in the prior month (JAMIA 2006).

* Over 30% of Epocrates physicians report saving more than 20 minutes a day.

* They have over 500,000 health care professionals worldwide including physicians, students, NPs, PA’s, nurses, pharmacists, etc. in their network.
Epocrates Rx® free drug reference gives access to over 3,300 drugs, free tools and applications such as drug interaction checking, medical calculators, formulary, Mobile CME.

Premium products include all the key decision support applications – drugs, diseases, and diagnostics, 1,200 diseases and conditions, 300 lab test panels, Medical Dictionary, Coder, - to name a few.

Both free and premium applications are continuously updated; so healthcare professionals always have the most current clinical information at their fingertips.

Bottom line -- Epocrates can help reduce the prevalence of defensive medicine.

To learn more about what Epocrates can do for you, visit them at Epocrates.com.

Sponsorship opportunities continue to be available. This can be via a Standard Blogad or a customized package. Please visit the advertising information page for further details.

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Monday, October 29, 2007

Why doctors get zero respect from the government

It comes down to campaign contributions, where physicians are being out-donated 7.5 to 1 by lawyers.

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Got pagers?

Why you should tie your scrub pants tight.

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MedBlog Power 8

10/25/2007 - 11/01/2007
Next revision: 11/01/2007



(Key: Rank, Blog name, Last week's rank, Post of note)

1) Surgeonsblog (1), Visual Fields

2) Made A Difference For That One (-), Come see us at work

3) Musings of a Distractable Mind (2), The Great Divide

4) The Physician Executive (5), MRSA Scare: A Primer

5) Health Beat (-), Universal Coverage – Why Massachusetts is the Last Place to Begin the Experiment

6) Diabetes Mine (3), Exubera Goes Phhhttt... What Now?

7) Suture for a Living (8), Poststernotomy Mediastinitis and Repair

8) Street Anatomy (-), The World’s Most Viewed Medical Animation

The MedBlog Power 8 is a list of medical blogs that have had an exceptional week of blogging, based purely on my subjective measures. Factors I consider are how provocative the posts are, the amount of discussion it generates, and posting frequency.

The list is revised every Thursday and will be published every 1-2 days on Kevin, M.D. If you want me to consider your exceptional week of blogging, you can contact me.

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Sid Schwab joins the MedPage Today blogging team

Respected writer and general surgeon Sid Schwab will be joining the blogging team over at MedPage Today's new blog. Dr. Schwab's Surgeonsblog is a perennial occupant at the top the MedBlog Power 8, and I am thrilled he will also be contributing his witty insights over MedPage Today.

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Inside Terrorism: The